Some risks still unknown with pregnancy and antidepressants

Roughly 20 percent of women will experience a depressive disorder while pregnant

By Lisa Applegate

Contributor

A new report about the risks versus benefits of taking
antidepressants during pregnancy confirms what many women already
know: the choice is rarely clear, or easy.

The American Psychiatric Association and the American College of
Obstetricians and Gynecologists jointly reviewed dozens of studies
about depression, antidepressants and pregnancy.

"They make it clear how much we don't know," says Dr. Laura
Miller, who until recently was the director of the University of
Illinois at Chicago Women's Mental Health Program.

Roughly 20 percent of women will experience a depressive
disorder while pregnant, according to the report. The use of an
antidepressant during pregnancy has doubled between 1999 and 2003,
largely due to greater use of selective serotonin reuptake
inhibitor antidepressants, or SSRIs, such as Prozac or Zoloft.

Some studies found that SSRIs, once thought to be safe for
babies, may cause complications such as low birth weight, preterm
birth, or-more rarely-problems with heart or lung function. But
researchers struggle to discern whether these problems are caused
by medications, or by the depression and its impact on maternal
health and behavior.

The report does include guidelines to help doctors and patients
make informed choices about drug treatment, something Dr. Xavier
Pombar, the director of obstetrics at Rush University Medical
Center, finds beneficial.

"I must counsel probably five women a week about this," he says.
"It's always the patient's choice. Oftentimes, we couch our
recommendations based on the patient's history."

Ideally, says Miller, women with a history of depression, or who
are bipolar or experienced psychotic episodes in the past, should
talk to a doctor before becoming pregnant. This way, a woman can
explore different options before she gets pregnant.

But, once pregnant, the most dangerous choice a woman can make
is to abruptly stop taking her medication before seeing a doctor.
Stopping can cause rebound symptoms that are more intense than the
original depression, Miller says.

"It's important not to make any changes until they go see a
psychiatrist, weigh the risks and benefits, and then perhaps decide
to gradually withdraw from medication," she says.

Lisa Applegate is a freelance writer and mom of one living in Chicago.